Estimating infant mortality from human immunodeficiency virus and other causes in breast-feeding and bottle-feeding populations.

This paper discusses the literature dealing with breast-feeding in women with human immunodeficiency virus (HIV) infection. This review is used to develop a background for a quantitative assessment of factors determining whether breast-feeding or bottle-feeding will result in a lower overall mortality in areas of different HIV prevalence. An algebraic formula is presented that enables calculation of the mortality that would result in any population if the following variables are known or capable of estimation: portion of childbearing women infected with HIV, portion of newborns infected with HIV at birth, relative mortality of breast-fed and bottle-fed infants that are not HIV infected, and transmissibility of HIV during breast-feeding. The information available for estimating these variables is incomplete. Nevertheless, boundaries can be set for each variable, based on information obtained locally or from the literature, to aid in objective evaluation of the risks of promoting bottle-feeding or breast-feeding in populations with different risk characteristics. Consideration of these factors indicates that the benefits of breast-feeding over bottle-feeding can substantially outweigh any putative risk of HIV transmission during breast-feeding unless the prevalence of HIV infection is quite high or the difference in mortality of breast-fed and bottle-fed infants is very low.